Provider Demographics
NPI: | 1164032926 |
---|---|
Name: | INTERNAL MEDICINE ASSOCIATES OF ROCHESTER HILLS, P.C. |
Entity Type: | Organization |
Organization Name: | INTERNAL MEDICINE ASSOCIATES OF ROCHESTER HILLS, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECT OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SARA |
Authorized Official - Middle Name: | ELIZABETH |
Authorized Official - Last Name: | GERHARDT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 586-946-5393 |
Mailing Address - Street 1: | 3616 N SHIMMONS CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | AUBURN HILLS |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48326-3912 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 586-946-5393 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1423 WALTON BLVD |
Practice Address - Street 2: | |
Practice Address - City: | ROCHESTER HILLS |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48309-1775 |
Practice Address - Country: | US |
Practice Address - Phone: | 586-946-5393 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-08-06 |
Last Update Date: | 2020-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |